NEW HAMPSHIRE HOSPITAL ASSOCIATION The following policy statements are intended to guide the development of Hospital Association positions on public policy issues and legislation through 2007 and 2008. For more information contact Mike Hill, President, or Leslie Melby, Vice President, Government Relations. ACCESS TO CARE The Association supports transitioning to guaranteed, universal access to health care for all Americans based on need, regardless of race, color, national origin, culture, language, religion, disability, age, sex, marital status, sexual preference or financial status. We believe that such a system should be funded mainly through taxes, supplemented by individual cost sharing. Sliding scale subsidies should be provided to low-income individuals and those with expensive, chronic conditions. An independent advisory commission should be established to provide strategic guidance, monitor program administration, and establish goals and objectives for health improvement. It should provide all Americans with medically necessary services including basic and catastrophic care, evidence-based preventive services, physician, hospital, home care, long term care, mental health care and prescription drugs. The private insurance market would cover excluded services such as elective or cosmetic surgery, as well as portions of beneficiary cost sharing. Employers could choose to offer private insurance coverage for excluded services to employees as part of their benefit package. Meanwhile, we support efforts to ensure that care provided is the most appropriate level of care necessary to meet patient needs. We support efforts to improve access to preventive and primary care, and efforts to ensure that the geographic distribution of healthcare services is appropriate. We also support efforts to expand access to services for the prevention and treatment of mental illness, substance abuse and other behavioral health conditions. We support expansion of existing government
sponsored health programs. In addition, we recognize that access
to affordable health care coverage through employment is
essential, so we support reasonable initiatives to expand the
availability and improve the affordability of private health
insurance coverage. We recognize that mental health is essential to the overall health and well being of the whole person. We also recognize that behavioral health problems are widespread, and are frequently involved as causal factors or complicating factors in many varieties of physical illness or disabling conditions. Providers also recognize that behavioral health problems are responsible for a disproportionate share of hospital admissions and visits to emergency rooms. The Association supports efforts to expand access to care and treatment for persons with behavioral health problems to achieve parity with other types of health services provided. We also support parity in terms of payment for behavioral health services to ensure that payment is adequate to meet the full financial requirements of Designated Receiving Facilities and other providers of inpatient, emergency and outpatient services for patients with behavioral health conditions. BILLING AND COLLECTIONS The Association recognizes that many people in New Hampshire have a difficult time accessing the health care they need because they cannot afford it. Hospitals have always provided free care to patients who are unable to pay. To assist lower income patients access financial help, the Association established the New Hampshire Health Access Network. To assist uninsured patients, the Association developed the Hospital Access Plus Program which guarantees a discount of at least 15% for medically necessary hospital services for patients without insurance. The Association recognizes that some patients are ineligible for public assistance programs or hospital-based assistance programs. We therefore support efforts to ensure fair billing and collection practices, including discount policies that are easily accessible and clearly state eligibility criteria, amount of discount, and payment plan options. CERTIFICATE OF NEED The Association recognizes that delivering health care is not business in the conventional sense. Often consumers are not at liberty to forgo accessing essential services for themselves or their loved ones regardless of cost or affordability, which means that there is little demand sensitivity in the marketplace. Care is generally paid for through intermediaries, so often there is little direct connection between consumption and payment and, accordingly, little price sensitivity. Additionally there is not a level playing field among competitors in the market because some providers, but not others, are required to provide certain services usually at a loss, or to make services available in locations or at times which would not be prudent from a strictly business perspective. Accordingly, the Association supports continuation of a certificate of need program which applies equally to everyone offering or proposing to offer healthcare services. We believe that the CON process offers the public an opportunity to participate in critical decision-making regarding availability of essential services that market forces working alone would not afford. We also believe that the CON process should take into account critical differences among communities and markets as it seeks to avoid unnecessary duplication of services, contain or reduce increases in costs and promote rational allocation of healthcare resources. COLLABORATION AND COMPETITION The Association endorses collaborative ventures where these contribute to conservation of resources, sharing of risks, improvements in the quality of services or overall community health status, better access to care for low income persons and people without health insurance, more effective use of expensive technology or enhanced management of care. We endorse competition in healthcare where it contributes to containing total healthcare costs, increases productivity in the development of the delivery of services, improves access to care, and affords consumers a wider range of choices in the marketplace. COMMUNITY BENEFIT New Hampshire’s community hospitals provide benefits that help meet essential health needs in their communities. Hospitals work with others in the community to assess local needs. First and foremost everyone in the community benefits by having timely and convenient access to emergency services, advanced healthcare technology and other conventional hospital services that hospitals provide around the clock. Another principal community benefit that hospitals provide is in helping care for medically indigent people in the community who are uninsured and underinsured and not otherwise eligible for government-sponsored health coverage. All hospitals in the state participate in the New Hampshire Health Access Network, which was established by the Foundation for Healthy Communities as a voluntary effort by health care providers to improve access to health care for low-income children and adults statewide. Other community benefits may extend beyond the conventional menu of services that hospitals are chartered to deliver depending on needs in the community and the hospital's capacity to help meet those needs. CONSENT TO TREATMENT The Association believes patients, or their legal guardians or duly authorized agents appointed under a durable power of attorney for healthcare, have a right to consent to or refuse treatment. In the absence of an authorized agent, we recognize the role of the family or significant other in helping to make surrogate decisions for patients who lack the capacity to make decisions about their healthcare treatment. DATA COLLECTION, TRANSPARENCY, AND REPORTING The Association supports disclosure of healthcare data when that data is useful to consumers and presented in a clear and understandable manner. We support the release of data where it clearly contributes to quality of care, containing cost increases, or enhancing patients' ability to make informed choices about services and providers. The Association opposes duplication of data collection efforts and regulations that require patients and/or private payers to bear the cost of state-sponsored data collection. We oppose the release of any healthcare data that may mislead the public. We also believe that providers have a right to maintain confidential commercial and financial information. EMERGENCY PREPAREDNESS The Association recognizes that hospitals play a unique role in statewide emergency preparedness planning. Community hospitals are looked to as community resources during a crisis situation and are considered first receivers. Hospitals pledge to work together through a Mutual Aid Agreement that they will assist each other during an event, whether as a result of natural, man-made, technological causes or mass casualty incident. Hospitals are also encouraged to coordinate activities with other community resources to ensure a cohesive response during a crisis situation. END-OF-LIFE CARE While hospitals strive for optimal care for all patients, we respect the right of each patient to make decisions about his or her care based on personal values and preferences. Advance care planning is the process we encourage to promote conversations among patients, their loved ones and health providers about a patient’s health choices. We believe that patients, working with providers, are entitled to pursue a painless and dignified death. Competent adults should have the right to refuse treatment, even if that decision results in death. The Association supports advance care planning laws that help ensure that a patient’s values and preferences are respected. ENVIRONMENTAL PROTECTION The Association recognizes the obligation of hospitals to protect the environment and health of the communities they serve. The Association supports the commitment of hospitals in their pursuits of environmental leadership and excellence and in their efforts to integrate environmental awareness and responsibility as priorities in their decision-making processes. The Association also supports the goals of the Hospitals for a Healthy Environment’s effort to reduce the volume and toxicity of hospital waste. HEALTH INSURANCE Private health insurance coverage obtained primarily through employment is the cornerstone of health financing for many working families in New Hampshire. Accordingly, we recognize that access to affordable health care coverage through employment is essential. Therefore, we support reasonable initiatives to expand availability and improve affordability of private health insurance coverage. The Association supports efforts to eliminate cost shifting from government to private payers. We advocate for more adequate Medicare and Medicaid payments to meet the full financial requirements related to providing the care delivered. Finally, we believe that state government should provide leadership in the effort to research and develop better health insurance programs and processes, such as the development of the New Hampshire Health Plan by using the state employees health insurance program, the largest insured group in the state, as a beta site for testing innovations in health insurance. HEALTH PROMOTION/PUBLIC HEALTH The Association recognizes health and wellness promotion and education, as well as prevention of accidents, illness and disability as important components of the continuum of health services. In our view, promoting healthy lifestyles and reducing preventable causes of hospitalization can be very effective in controlling healthcare costs. MEDICAL AND HOSPITAL LIABILITY INSURANCE AND TORT REFORM The Association supports efforts to improve the availability and affordability of medical and hospital liability insurance. We support tort law system reforms that foster speedy and fair resolution of disputes, reduce litigation expenses through alternative means of dispute resolution and pretrial screening panels, reduce rates on prejudgment interest, institute caps on judgments, and develop less costly and more efficient insurance mechanisms. MEDICARE We advocate for Medicare payments to providers being adequate to meet the full financial requirements related to providing the care delivered, including recognition of high labor costs in the hospital payment methodology. MEDICAID The Association supports reforms to Medicaid that assure access to services by expanding the network of primary care providers to promote better management of care, rational utilization of emergency room services, prevention, early intervention and improved cost-effectiveness overall. We support expansion of Medicaid eligibility to cover men, women and children in families with incomes at or below 200% of the federal poverty level. We advocate for Medicaid payments to providers being adequate to meet the full financial requirements related to providing the care delivered, as well as to eliminate cost shifting from Medicaid to private payers. Reduced Medicaid payment to hospitals is a significant factor in the cost shifting phenomenon. We also believe that Medicaid funding should be used for the purposes for which it is intended. PATIENT SAFETY AND QUALITY The Association supports evidence-based, cost effective efforts to improve health status, clinical outcomes and access to care. We support systematic efforts to continuously improve quality of care and patient safety through collaborative initiatives involving hospitals, physicians, health plans, consumers and other purchasers, regulators and others. We endorse the industry's initiatives to monitor and improve quality, including the shield of confidentiality that makes it possible to carry out that function effectively. We believe that healthcare facilities should be held accountable for quality of care through appropriate methods of survey, such as Joint Commission on Accreditation of Healthcare Organizations or Medicare Survey and Certification. PAYMENT SYSTEMS The Association advocates fairness in contracting, pricing and payment systems with the objective of ensuring that the cost of meeting the full financial requirements of providers be distributed equitably among all payers, including Medicare and Medicaid. We believe that payers should process complete and accurate claims in a timely manner based on reasonable payment practices and state requirements. We support national efforts among insurers, providers and government to simplify patient billing in order to produce and communicate clear, concise and correct billing information on a timely basis. In addition, we believe that payers should establish uniform contract provisions that ensure optimal use of information technology, reasonable precertification requirements, consistent medical necessity definitions, streamlined credentialing processes, and increased communication with providers. PRICING TRANSPARENCY The Association believes that people deserve meaningful information about the price of their hospital care. Hospitals are committed to sharing information that will help people make important decisions about their health care. Sharing pricing information is more challenging because (1) hospital prices can vary based on patient needs and the services they use, (2) hospital prices reflect the added costs of hospitals’ public service role serving the essential health care needs of a community 24 hours a day, seven days a week, and (3) a hospital’s prices can not yet reflect important information from other key players such as the price of physician care while in the hospital or how much of the bill a patient’s insurance company may cover. However, more can, and should, be done to share hospital pricing information with consumers. PRIVACY Patients have a right to expect that their personal health information will be treated as confidential. While we understand third-party payers, government agencies and others have a legitimate need for patient information, patients, in most cases, should have a right to formally authorize access. We will carefully weigh the merits of proposals for expanding or restricting access to patient information, against patients' legitimate rights to expect their personal information will remain confidential, consistent with the New Hampshire Patient Bill of Rights and HIPAA (Health Insurance Portability and Accountability Act of 1996). We support legislation that provides reasonable uniformity among states as a way to avoid confusion regarding privacy and security and release of medical information between patients, providers and third parties, especially across state borders. PROFESSIONAL LICENSURE AND CERTIFICATION The Association supports licensure and/or certification of health professionals where unregulated practice presents a clear and present public danger, where there is no reasonable alternative to licensure/certification, and proposed licensure/certification requirements identify required competencies and provide an effective method for assuring proficiency. We support regulatory changes which allow licensed or certified professionals to expand their scope of practice when such expansion supports innovations and efficiencies in the delivery of quality patient care while maintaining patient safety. RURAL HEALTH The Association recognizes that most of New Hampshire is rural, and that providing hospital and other essential health services in rural communities is especially challenging. We recognize that hospitals and other organizations providing services in rural New Hampshire are typically small and usually subject to more volatility in terms of utilization, staffing and financial condition than are larger organizations serving more urbanized areas. We support efforts to ensure that the state provides reasonable assistance in assuring access and quality of rural providers. SAFETY NET PROVIDERS The Association supports efforts to ensure that hospitals and other providers that serve vulnerable populations survive and thrive. Hospitals play a key role in providing a safety net for people who cannot afford the care they need and do not qualify for private or public assistance. The Association believes that providers who provide care for the medically underserved, providers who provide emergency services around the clock, and providers who provide care in rural areas are all essential community providers. We believe that health plans and provider networks should collaborate with providers of essential community services to ensure that those services can be sustained for underserved populations and others who depend on them being there. TAX EXEMPTION FOR NOT-FOR-PROFIT HEALTH ORGANIZATIONS The Association believes that hospitals, as charitable institutions, provide community benefits that work to satisfy the health needs and improve the health status of New Hampshire citizens. Not-for-profit community hospitals have been granted limited tax exemption because of the Legislature’s recognition that hospitals perform a vital community service. We support tax exemption for not-for-profit hospitals and health organizations. We support property tax exemption that applies to property that is owned, used and occupied directly for activities within a health organization’s charitable purpose. TOBACCO USE PREVENTION We recognize that tobacco use in New Hampshire is taking its toll on citizens and the economy. The U.S. Surgeon General concluded that smoking is the single greatest avoidable cause of disease and death for both smokers and non-smokers. New Hampshire hospitals are committed to the well being of the state’s citizens. We therefore support all initiatives designed to reduce smoking and other tobacco use, including an increase in New Hampshire’s tobacco tax and clean indoor air mandates. WORKFORCE DEVELOPMENT Hospitals are committed to the recruitment and retention of qualified personnel. Hospitals are also committed to maintaining fair and equitable employment practices and policies that do not discriminate on the basis of race, color, national origin, religion, disability, age, gender, marital status, or sexual orientation. The Association believes that the healthcare worker shortage is a public health issue that will require commitment of more public and private resources to enhance the capacity for recruitment, retention and education.
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